WQ0041498_Application (FTSE)_20200219

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Greensboro. NC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Michael Borchers per 15A NCAC 02T .0106(b)
Title: Water Resources Department Director
4. Applicant's mailing address: 2602 S. Elm -Eugene Street
City: Greensboro State: NC Zip: 27406-_
5. Applicant's contact information:
Phone number: [phone] Email Address: mike.borchersagreensboro-no.gov
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
NC Department or
Environmental Quality
Received
1. Project name: 2020 Townsend Water Treatment Plant Improvements
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.18. Longitude:-79_73,
5. Parcel ID (if applicable): 78618
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: David Baird License Number: 013453
Firm: Arcadis
Mailing address: 7029 Albert Pick Road Suite 101
City: Greensboro State: NC Zip: 27409-_
Phone number: [phone] Email Address: david.baird(abarcadis.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. Osborne Water Reclamation Facility Permit Number: NCO047384
Owner Name: City of Greensboro NC
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00006
Owner Name(s): City of Greensboro NC
FEB 19 2020
Winston-Salem
Regional Office
FORM: FTA 04-16 Page] of 5

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes NNo ❑N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Aereement (FORM: DEV) been attached?
❑ Yes NNo ❑N/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM: FICA) been attached?
❑ Yes NNo ❑N/A
4. Origin of wastewater: (check all that apply)
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home N Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
L-----*Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes []No
➢ If yes provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow e,b
No. of Units
Flow
Factories or businesses with showers
35 gal/employee per shift
29.25
1023.75 GPD
Public access restroom facilities
50 gal/plumbing fixture
4
1300 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
2323.75 GPD
a See 15A NCAC 02T 0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 2323.75 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 470 Ductile Iron
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Lake Townsend Lift Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36_18° Longitude:-79_73°
3. Design flow of the pump station: 0.002 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 60 gallons per minute at 98 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
3
4458
HDPE
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
® Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g) ® Yes ❑ No
D 15A NJCA(' 09T M05(f) rnntains minimum senarations that shall he nrovided for sewer systems:
Setback Parameter
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top sloe of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria f latest version) as applicable?
® Yes ❑ No
IfNo, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
r i d t-C- ;3A.5 t—d attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
Za ze
SFW A0r VA 0 WI'SS 54Ar7 AD CATFC
3. Applicant's Certification per 15A NCAC 02T .0106(b):
attest that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: 2-0 2-0
FORM: FTA 04-16 Page 5 of 5

FTA 04-16, VIA, Origin of wastewater:
The wastewater being handled in this project originates from two sources:
• The sanitary sewage (bathrooms with sinks & showers) from the Townsend Water Treatment Plant.
• The Lake Townsend Marina restrooms.

State of North Carolina
iN,J%ion of Water Rr,our;:es
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Greensboro, NC
Project Name for which flow is being requested: 2020 Townsend Water Treatment Plant
More than one FTSE may be required for a single project if the owner of the fVWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T.Z. Osborne Water Reclamation Facility
b. WWTP Facility Permit #: NCO047384
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
40.0
2.665
29.87
0.002
32.537
81.34
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B) (C) (D)=(B+C)
(E)=(A-D)
Design
Obligated,
Pump Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow**
Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pt),
Avg. Daily Daily Flow, Obligated
Available
Number) No. MGD MGD
Flow, MGD MGD Flow
Capacity***
Reedy 6.0 2.4
1.681 .172 1.853
.547
The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Discharges into gravity sewer, then LS
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I C(S�n �� p�,L1 certify to the best of my knowledge that the addition of
the ov lume of wastewater io be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and 11 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
2
Page 2 of 6
FTSE 10-18

ow
Lake Townsend f �y
Townsend WTP,� ^ `
t
r'
1
r 61
SSMF416087
Legend
- Proposed Lift Station
Proposed Sanitary Sewer
— Proposed Sanitary Sewer Force Main
0 250 500 1,000
Feet
NOTE:
1. USA Topo Map from ESRI Basemaps
1:
Downstream Sewer Information
System Wide Permit Number: WQCS00006
TZ Osborne Waterwater Treatment Plant NCO047384
201.3 National Geod�agptsociety, i-cubed,
,�`Gopyright©
Townsend WTP Sanitary Sewer PS & FM
Site Map
IRCJaDIS Uesign&Cis onsultancy FIGURE
tornatue1
built assatets

Legend
Proposed Lift Station
Proposed Sanitary Sewer
-�^ Proposed Sanitary Sewer Force Main
0 250 500 1,000
Feet
NOTE:
1. 2018 Orlhoimagery from NC One Map, ArcGIS Online
Downstream Sewer Information
System Wide Permit Number: WQCS00006
TZ Osborne Waterwater Treatment Plant NCO047384
Townsend WTP Sanitary Sewer PS & FM
Aerial Map
RCJaDIS Design&Cansultanry FIGURE
torttasses 2
butltassets

N C Department of
Environmental Quality
Received
FEB 19 2020
Winston-Salem
Regional Office
PARCJaDIS OesignBConsuttancy
fornatu tan
NC Department of Environmental Quality — Division of Water Resources
Water Quality Permitting — PERCS Unit
Mail
450 West Hanes Mill Rd.
Suite 300
Winston Salem, NC 27105
Subject:
Greensboro, North Carolina
2020 Townsend Water Treatment Plant Improvements
Sewer Extension Permit Application
To Whom it May Concern:
We are pleased to submit the enclosed Sewer Extension Permit application
for gravity sewer and force mains, on behalf of the City of Greensboro, for
your review and approval.
The subject project includes the construction of a gravity sewer, sewage lift
station, and force main to replace the aging sewage infrastructure at the site
of the Townsend Water Treatment Plant and the abandonment of the existing
leach fields at the Townsend Water Treatment Plant and the lift station at the
Lake Townsend Marina.
Arcadia G&M of North Carolina,
Inc.
7029 Albert Pick Road
Suite 101
Greensboro
North Carolina 27407
Tel [phone]
w .arcadls.com
WATER DIVISION
Dale:
February 18, 2020
Contact:
Dennis Kachmarsky
Phone:
704-544-5483
Email:
[e-mail]
Our ref:
GRGRN160.DO01
ARCADIS G&M of North Carolina, Inc.
The proposed gravity line consists of approximately 470 LF of 8" sewer. The NC Engineering License# C-1869
line will start at the existing septic holding tank on the site of the Townsend NC Surveying License If C-1869
Water Treatment plant, running southwest towards and connecting to a
proposed sewage lift station on the northern end of the Lake Townsend
Marina property.
The proposed force main consists of approximately 4,458 LF of 3" HDPE.
The line will start at the proposed lift station on the northern end of the Lake
Townsend Marina property and will run through the marina property towards
Townsend Rd., then will follow the road to 500' past the entrance to the Bryan
Park golf course and conference center, where it will run southwest, tying in
to existing COG MH 16087.
arcadis.com Page:
G:\PROJECT\Greensbcro NC\Townsend WrP -Sanitary PS a FM Project(GRGRN16O.DDDt)\Regulatory\DEO-PERCS\Sewer Extension Packens
- Cover Letter 1 /2

February 13, 2018
The gravity sewer and force main proposed by this project meets the Minimum Criteria.
The following enclosures are included as part of this application:
• A check in the amount of $480
• One (1) original and one (1) copy of the following documents
o FTA 04-16 application form
o Completed and signed FTSE 04-16 form
o Two Site Maps
o Attachment to FTA 04-16 for origin of wastewater
We trust this information is complete and will facilitate your review. Please feel free to contact us with any
questions or concerns regarding the application. We appreciate your assistance with this important project
for the City of Greensboro and we look forward to your approval.
Sincerely,
Arcadis G&M of North Carolina, Inc.
Dennis Kachmarsky, PE
Project Engineer
Copies:
Jay Guffey, City of Greensboro
Michael Borchers, City of Greensboro
David Hamilton, Arcadis
arcadis.com Page:
GAPR0JECT,Greensb=NC1Townsend WrP -Sanitary PS & FM Project(GRGRNI6D.DDDt)\RegulatorADEO-PERCSISewer Extension Packe6B
- Cover letter 2/2